Bulbar Onset Generalized Myasthenia Gravis in an Elderly Patient: A Diagnostic Challenge.

Myasthenia gravis (MG) can present with variable and atypical symptoms, particularly in older adults, where isolated bulbar involvement may mimic stroke or motor neuron disease. We report a case of an elderly patient with late-onset, acetylcholine receptor (AChR) antibody-positive generalized myasthenia gravis who initially presented with ptosis, followed by progressive dysphagia and dysarthria, and subsequently developed head drop. Electromyography (EMG) confirmed a neuromuscular junction disorder, and serology demonstrated markedly elevated AChR antibodies. Early initiation of pyridostigmine and corticosteroids led to rapid clinical improvement, with the Myasthenia Gravis Activities of Daily Living (MG-ADL) score decreasing from 11/24 to 0/24 within three weeks. This case highlights the importance of considering MG in elderly patients presenting with isolated bulbar symptoms and demonstrates the diagnostic value of electrophysiology and antibody testing for timely treatment.